Nursing Education Review unveils vision for nurses of the future

Exams to assess whether graduates are fit for registration, extending the length of the Bachelor of Nursing Degree, boosting the minimum number of clinical placement hours, realigning NP education towards primary care and establishing a national campaign to attract under-represented groups to nursing such as men are among 26 recommendations outlined in the Report of the Independent Review of Nursing Education released this week.

The wide-ranging review also calls for the regulation of assistants in nursing (AINs) to protect the public, the accreditation and monitoring of nursing courses undertaken by the Australian Nursing and Midwifery Accreditation Council (ANMAC) to be made public, formal accreditation and monitoring of clinical placements, and better integration between workforce planning and education so nursing students secure jobs as they enter the profession.

The report, Educating the Nurse of the Future: Report of the Independent Review of Nursing Education, furthermore pinpoints emerging trends affecting nursing education, listing ageing and mental health as areas educational institutions should focus more on to better prepare nurses for practice and the broader role they play in healthcare.

Other recommendations include developing a national web-based transition-to-practice program (TPP) that all nurses should complete in their first year, specific learning outcomes and assessments to ensure inter-professional learning is not neglected, the development of guidelines about health informatics and digital health technologies, determining the ideal mix of online and face-to-face teaching, and a push to increase the number of nursing academics.

NMBA practice standards should also specify the core knowledge, skills and procedural competence newly registered ENs and RNs require to work in any setting to make nursing education more consistent, according to another recommendation.

The independent review, commissioned by the federal government and undertaken by Emeritus Professor Steven Schwartz, set out to examine the current educational preparation of Australian nurses to ensure they are adequately equipped to meet the future needs of the nation’s evolving health system.

Its scope included exploring the effectiveness of educational preparation and articulation between enrolled and registered nurses and nurse practitioners in meeting the needs of health service delivery, factors that affect the choice of nursing as an occupation and the worth of Australian nursing qualifications globally.

The review was shaped by extensive consultations across Australia, with more than 1,100 educators, clinicians, supervisors, policymakers, patient groups, students, managers and unions providing feedback.

“I debated and discussed with a wide range of people and organisations, some of the most controversial questions facing nursing education,” Professor Schwartz says in the report.

“What skills and attitudes do we expect graduate nurses to have, and what is the best way to teach them? How do we widen participation in nursing and meet the needs of the regions?”

The review also received 84 written submissions, including from the Australian Nursing and Midwifery Federation (ANMF), commissioned four research papers and conducted surveys of targeted groups.

The ANMF’s submission outlined how nursing education in Australia is largely in good shape and tabled 17 recommendations focused on key areas that need attention including better support for newly qualified nurses in their grad year and the need to implement clinical supervision, more opportunities for nurses to complete a Master’s degree leading to endorsement as a nurse practitioner, improving the experience of students on clinical placements, and re-evaluating the theory and practice experiences of nursing students relating to the provision of aged care.

Professor Schwartz said the review provided an opportunity to explore nursing education in the context of modern Australia – a larger, more ethnically diverse and gradually ageing population.

He said it would be a mistake to think Australian nursing education is flawed or second-rate but acknowledged processes, practices and procedures could work better.

“The review found much that is excellent about nursing education, but it also found areas that could be improved,” he explains in the report.

“These include increasing the diversity of the nursing workforce, providing easily navigable career paths, fostering inter-professional collaboration, and ensuring that all nurses are adequately prepared for their roles.”

The report provides in-depth analysis across a range of topics and makes thought-provoking recommendations for improvement.

One of the most interesting recommendations calls for research into extending the length of the current three-year Bachelor of Nursing Degree, considered too short by some.

Options discussed within the report include adding an extra semester or full-year or requiring all students to begin their education with an EN diploma before articulating to a Bachelor of Nursing degree, which would likely require transferring the education of enrolled nurses from the VET sector to higher education to increase compatibility.

Another recommendation argues outcomes-based cognitive and behaviour assessments used to test whether internationally educated nurses are safe to practise in Australia should become the norm for local graduates.

The report says despite practice standards, there is no independently administered pre-registration exams to ensure nurses meet them, unlike within other health professions such as psychology, medicine and pharmacy.

“Starting soon, the NMBA intends to use examinations to judge whether internationally educated nurses are fit for registration.

“Examining all graduates in the same way would provide vital insights into Australian nursing education.”

Covering the quality of professional experience placements, the report found the increase in nursing students has made finding relevant clinical placements difficult and even when quality placements are available they are considered too short to provide real benefit.

In response, the report recommends the formal accreditation and monitoring of placements to “ensure that every student acquires what the practice standards demand: “the skills and knowledge necessary for safe and effective practice”, along with standardising the minimum number of hours required in Bachelor of Nursing courses at 1,000 hours.

In line with changing demographics and healthcare needs, the report looked at the lack of diversity within the profession, noting that just 12% of Australia’s nurses are male and that ethnic minority groups are also under-represented, with about 1% of nurses Aboriginal or Torres Strait Islanders.

The report suggests a diverse nursing workforce could help reduce health disparities that exist between most Australians and minority groups, and that steps to attracting under-represented groups to the profession should include a national awareness campaign and creating better pathways.

In regard to nurse practitioners, the report argues Master’s degree courses will need to be redesigned with a primary care focus to reflect the current rebalancing of nursing from acute to primary care.

It states NPs were conceived in the US as mid-level primary care providers for under-served areas, but in Australia instead became a way for specialist nurses to gain recognition for their professional skills.

“In line with national health priorities, NP education should be oriented toward primary care, particularly in the regions,” the recommendation reads.

“Advanced practice requirements should be revised to encourage the formation of the broad skills required in primary practice. Expertise should be demonstrated by independent assessments. Access to the Medicare Benefits Schedule for NP services should be reviewed.”

The final report of the Independent Review of Nursing Education now sits with Federal Health Minister Greg Hunt and the government to consider recommendations.

Professor Schwartz has nominated the National Nursing and Midwifery Education Advisory Network (NNMEAN) as the appropriate body to oversee and monitor the implementation process of the review’s recommendations and says the government should consider a follow-up review after four years to assess progress.

Read the full report here.

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